Heart rate-based protocols for exercise challenge testing do not ensure sufficient exercise intensity for inducing exercise-induced bronchial obstruction

Trümper, Christian; Mäueler, Sebastian; Vobejda, Christian; Zimmermann, Elke

doi:10.1136/bjsm.2007.041715

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…Monitoring ventilation requires the patient to breathe through a mouthpiece or mask, which adds some burden to conducting the test. An acceptable alternative is a target heart rate of >85% of the predicted maximum (calculated as 220 − age in years) [84,85]; however, the approach based on heart rate may not always achieve the target ventilation [86], and higher heart rate targets can be associated with more bronchoconstriction [83]. Measurement of pulmonary gas exchange during exercise makes it possible to quantify the intensity of exercise as a fraction of predicted peak oxygen uptake, confirming the adequacy of exercise challenge.…”

Section: Exercise Challenge Testingmentioning

confidence: 99%

ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing

et al. 2018

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Recently, this international task force reported the general considerations for bronchial challenge testing and the performance of the methacholine challenge test, a “direct” airway challenge test. Here, the task force provides an updated description of the pathophysiology and the methods to conduct indirect challenge tests. Because indirect challenge tests trigger airway narrowing through the activation of endogenous pathways that are involved in asthma, indirect challenge tests tend to be specific for asthma and reveal much about the biology of asthma, but may be less sensitive than direct tests for the detection of airway hyperresponsiveness. We provide recommendations for the conduct and interpretation of hyperpnoea challenge tests such as dry air exercise challenge and eucapnic voluntary hyperpnoea that provide a single strong stimulus for airway narrowing. This technical standard expands the recommendations to additional indirect tests such as hypertonic saline, mannitol and adenosine challenge that are incremental tests, but still retain characteristics of other indirect challenges. Assessment of airway hyperresponsiveness, with direct and indirect tests, are valuable tools to understand and to monitor airway function and to characterise the underlying asthma phenotype to guide therapy. The tests should be interpreted within the context of the clinical features of asthma.

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Section: Exercise Challenge Testingmentioning

confidence: 99%

ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing

et al. 2018

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“…Correspondingly, the guidelines recommend an exercise intensity of 80% -90% of maximum heart rate (HR max ), estimated by the formula HR max = 220 − age, the last 4 minutes of the test [6]. However, as there is high individual variance in HR max [9], it has been reported that heart rate based on ATS standard protocols may not ensure sufficient exercise intensity to induce bronchoconstriction [10]. Moreover, a study by Carlsen et al [11] has demonstrated a significantly increased reduction in lung function after an ECT performed at 95% of estimated HR max compared to an intensity of 85% of estimated HR max .…”

Section: Introductionmentioning

confidence: 99%

“…The HR formula recommended by the ATS, as described above, is usually applied [13]. Trümper et al [10] have suggested that, in order to ensure adequate intensity of a test, individual aerobic capacity should be achieved before conducting an ECT. Conducting a repeated ECT introduces the possibility to adjust the exercise intensity on an individual basis, and the subject tested becomes familiarized with the testing procedure.…”

Section: Introductionmentioning

confidence: 99%

Exercise-Induced Bronchoconstriction Diagnostics: Impact of a Repeated Exercise Challenge Test

Angell¹,

Augestad²,

Haugen³

et al. 2014

OJRD

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Exercise-Induced bronchoconstriction (EIB) is related to increased ventilation (VE) during exercise and describes the transient airway narrowing following exercise. A reliable diagnosis is essential for optimal treatment. The impact of a repeated exercise challenge test (ECT) in a clinical setting is not well established and conducting a repeated ECT with the possibility to adjust the exercise intensity on an individual basis may give more information. The aim of the study was to evaluate the test-retest reliability of an ECT for EIB and its association with exercise intensity. Methods: After examination by a pulmonologist, 20 referred subjects with symptoms strong indications of Exercise-Induced bronchoconstriction performed two consecutive exercise challenge tests on a treadmill. The exercise intensity of the repeated test was adjusted. Forced expiratory volume in 1 second (FEV1) was measured before and 1, 3, 6, 10, and 15 minutes after exercise. EIB was defined as a reduction of ≥ 10% in FEV1. Ventilation and heart rate were measured during exercise. Results: Five subjects tested positive in both tests, and ten subjects tested negative in both tests. Three subjects tested positive in the first test only, while two subjects tested positive in the second test only. The exercise intensity was not significantly different between the two tests for any of the subjects. Conclusion: There were 25% divergences in the diagnostic results of two consecutive exercise challenge tests. The difference in the test results was not explained by a difference in the exercise intensity.

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Guidelines for the Study of Nonspecific Bronchial Hyperresponsiveness in Asthma

Tordera

Río

Gutiérrez

et al. 2013

Archivos de Bronconeumología (English Edition)

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Heart rate-based protocols for exercise challenge testing do not ensure sufficient exercise intensity for inducing exercise-induced bronchial obstruction

Cited by 5 publications

References 19 publications

ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing

ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing

Exercise-Induced Bronchoconstriction Diagnostics: Impact of a Repeated Exercise Challenge Test

Guidelines for the Study of Nonspecific Bronchial Hyperresponsiveness in Asthma

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